Northeast Syria, October 2018 Humanitarian Situation Overview in Syria (HSOS)

Northeast Syria, October 2018 Humanitarian Situation Overview in Syria (HSOS) Introduction Coverage Communities assessed (449 of 2,349) HSOS is a monthly assessment that aims to provide comprehensive, multi-sectoral information about the humanitarian situation inside Syria. The assessment is conducted at the community level covering displacement, shelter and non-food items (SNFI), health, water, sanitation and hygiene (WASH), food security and livelihoods (FSL), and education. TURKEY Of which 99 are located in hard to reach areas Sub-districts assessed (41 of 47) Abu Qalqal Maskana Al-Khafsa ALEPPO Darbasiyah Ain al Arab Lower Shyookh Menbij Amuda Tell Abiad Ein Issa Sarin Suluk Al-Thawrah Mansura Karama AR-RAQQA Sabka Quamishli Be'r Al-Hulo Al-Wardeyyeh Tal Tamer Areesheh Jurneyyeh Ras Al Ain Jawadiyah Al-Malikeyyeh Qahtaniyyeh Tal Hmis Ya'robiyah For community-level data, datasets are available on the REACH Resource Centre, the Humanitarian Data Exchange, and are also distributed through partners across the humanitarian community. Hole Shadadah AL-HASAKEH Maadan Tabni DEIR-EZ-ZOR Top 3 reported priority needs in assessed communities: Markada Kisreh Khasham Sur The factsheet presents information gathered in 449 communities across (100 communities), (183 communities), (121 communities), and northeast Aleppo (45 communities) governorates. Data was collected during the month of November 2018, and refers to the situation in the northeast region in October 2018. Findings are indicative rather than representative, and should not be generalised across the region. IRAQ Al Mayadin 2,005,806 total PIN Thiban Jalaa HOMS Abu Kamal 1,051,906 953,900 Survival Minimum Expenditure Basket (SMEB):1,2 Hajin Ashara 3 Education People in need (PIN) Demographics* Basira Muhasan 2 Livelihoods 1 Healthcare Susat Average price in October 2018: 59,936 Syrian pound (SYP) One month change: -2.9% Six month change: +3.2% * Figures based on HNO 2018 population data for the entire NES region including areas not covered by HSOS. Key events impacting the humanitarian situation in NES and cities fully liberated from ISIL.a,b Forces escalate offensive on ISIL in southeastern governorate and in southern AlHasakeh governorate.c 233,000 spontaneous returnees reported in governorate since November 2017.d Ongoing offensive to retake final ISIL-held enclave in southern rural results in more than 27,000 displacements.d Deterioration of agricultural infrastructure and inputs and a drought in NES result in lowest annual wheat yield since 1989.e Downward trend in reported spontanous returns to Ar- Raqqa city as conditions remain unconducive for returns.d October-November 2017 April 2018 November 2017-October 2018 June-October 2018 October 2018 Ongoing

CONTEXT During October 2018, the offensive to regain control over the last remaining pockets under the influence of the so-called Islamic State of Iraq and the Levant (ISIL) in southeastern Deirez-Zor continued and resulted in further destruction of civilian infrastructure and casualties. f Furthermore, adverse weather conditions throughout northeast Syria (NES), including heavy rain and flashfloods worsened the situation for internally displaced persons (IDPs), especially those residing in tents. For further information on the situation in city and please see the Area-Based Assessment of City and the Situation Overview and Gap Analysis assessments. KEY HIGHLIGHTS 3 School curriculum as barrier to accessing education services in Of the 183 assessed communities in governorate, key informants (KIs) in 44% reported that education was a top priority need. While KIs in 98% of assessed communities reported the presence of a functioning primary school, in only 56% and 20% respectively, KIs reported having a functioning secondary school (7th-9th grade) and high school (10th-12th grade). In addition, KIs in 50% of assessed communities reported that not all school aged children had access to education services in October. The most common barrier reported by KIs in 27% of assessed communities was that parents disapproved of the curriculum used in schools. Furthermore, other reports indicated a wider issue concerning curriculum in. f Poor water quality and access in In October, KIs in 55% of the 100 assessed communities in governorate reported that the network was the primary source of drinking water. Additionally, water trucking was reported the primary source by KIs in 35%. KIs in 54% of the assessed communities reported that there was an insufficient amount of water to meet household needs. In addition, in 22% of assessed communities KIs reported that water from the primary source tasted and/or smelled bad and in 16% KIs reported that it made people sick after drinking. Furthermore, diarrhoea was reported as one of the most common health problems by KIs in 53% of assessed communities. This suggests that some health issues were possibly exacerbated by the quality of water. Lack of affordable healthcare in Of the 121 assessed communities in, KIs in 65% reported that healthcare was a top priority need. Despite that KIs in 93% of assessed communities reported the presence of functioning healthcare facilities, in 91% they reported that those were primarily private healthcare facilities, often associated with higher costs. In addition, the top two reported barriers to accessing healthcare were the high cost of healthcare services reported by KIs in 71% of assessed communities and the high cost of transportation to healthcare facilities reported by KIs in 68% of assessed communities, suggesting that a lack of affordable healthcare and/or affordable transportation to facilities in impacted access to healthcare in October. Humanitarian situation overview in Menbij district, Aleppo governorate Information gaps in Menbij district limit the capacity of humanitarian actors to effectively respond to area needs. To address this, REACH scaled up coverage throughout the district in October. Please see the Menbij District October 2018 area profile for a detailed situation overview. Displacement 4 An estimated 371,620 IDPs reportedly resided in the 449 assessed communities in NES, representing approximately 15% of the total population in assessed areas (2,558,240). The highest concentrations of IDPs were reported in Tal Nasra (Al- Hasakeh), Moezleh (), and Abu Kabret Al Rashid () communities. KIs reported an estimated 3,200 spontaneous refugee returnees to 47 assessed communities in NES from Lebanon, Iraq, and Turkey. The most common reasons that KIs reported for return were family reunification in 70% and a reported lack of economic opportunity in the host country in 68%. Food Security & Livelihoods Among the 449 assessed communities in NES, KIs in 77% reported that some food staple items were too expensive and in 71% that there was a lack of financial resources to buy available food in markets. Of the 304 assessed communities in and governorates, KIs reported that in 28% there was an inability to access bread on a daily basis. As most common barriers, KIs in 75% of assessed communities reported that electricity/fuel for bread production was too expensive or difficult to access and KIs in 54% reported an insufficient availability of electricity/ fuel for the production of bread. Education In eastern Aleppo,, and governorates, KIs in only 29% of the 266 assessed communities reported that all children had access to education services. This was primarily due to a lack of school supplies reported by 49% of KIs and a lack of teaching staff reported by 41% of KIs in the assessed communities. KIs in 30% of all 121 assessed communities in reported early marriage as one of the most common reasons for school aged children to not attend school during the previous month. WASH Across the 449 assessed communities in NES, KIs in 51% reported the water network as the main source of water and in 25% water trucking as the main source. In addition, KIs in 83% of the 349 assessed communities in eastern Aleppo, and governorates reported that there was a sufficient amount of water to meet household needs. However, in Ar- Raqqa governorate KIs in only 46% of the 100 assessed communities reported that there was a sufficient amount of water to meet household needs and KIs in 22% reported that water tasted and/or smelled bad in October. Health KIs in 53% of the 449 assessed communities reported that there were no functioning medical facilities in their community. The majority of these communities were located in eastern Aleppo,, and governorates. Of the 121 assessed communities in, KIs in 70% reported psychiatric care and in 62% psychosocial support as the top needed healthcare services in October. Among the 45 assessed communities in eastern Aleppo, antenatal care was reported amongst the most needed healthcare services by KIs in 73% of assessed communities. Additionaly, KIs in 56% of the assessed areas in eastern Aleppo reported pregnancy related diseases as one of the most common health problems. Shelter and NFI In eastern Aleppo and governorates, KIs in 72% of the 166 assessed communities reported that community generators were the most common electricity source in October. In contrast, KIs in 58% of the 283 assessed communities in and governorates reported that the network was the main source of electricity in October. *The eastern part of Aleppo where humanitarian response and coordination is conducted from the northeast rather than the northwest. 2

Northeast Syria, October 2018 Regional areas of influence: Area of influence Sourced from Live UA Map, 31 October 2018 Opposition - Free Syrian Army (Olive Branch/Euphrates Shield) TURKEY Democratic Federation of Northern Syria - Syrian Democratic Forces (SDF-coalition) ISIL-affiliated groups ALEPPO Assessed Community AL-HASAKEH AR-RAQQA IRAQ HAMA DEIR-EZ-ZOR HOMS 3

Northeast Syria, October 2018 DISPLACEMENT4 Estimated proportion of pre-conflict population (PCP) displaced from community: 6,430-7,930 Estimated number of IDP arrivals in assessed communities in October. 3,750-4,770 Estimated number of spontaneous returns in assessed communities in October.5 Assessed Cities Communities with the largest estimated number of IDP arrivals: Gharanij () 1,000-1,500 Eastern Jarda () 1,000-1,200 Abu Hardoub () 1,000-1,100 AL-HASAKEH ALEPPO Quamishli AR-RAQQA Top 3 reported subdistricts of origin for IDP arrivals:6,7 Hajin ( governorate) HAMA Susat ( governorate) Estimated percent of pre-conflict population displaced from community as of October () / Ain al Arab (Aleppo) 0-24% 25-49% 50-74% 75-100% 440 communities reported no PCP departures.8 Top 3 reasons for PCP departures in the remaining 9 assessed communities:6,7,9 H O Massessed S Sub-district with one or more communities reporting spontaneous returns this month Reduced access to basic services 56% Sub-district with no assessed communities reporting spontaneous returns this month Escalation of conflict 44% Access to money to pay for departure 33% 4 DEIR-EZ-ZOR Neighbourhood reporting spontaneous RU R A L this month returns DAMASCUS

FOOD SECURITY & LIVELIHOODS Communities that reported having an insufficient quantity of food: 11 38/449 87/449 0 Communities reported having received food distributions in the last month. Communities reported that residents were unable to access shops and markets. 50,000-100,000 SYP Most commonly reported household monthly income range. 1 Borrow money from family/friends Children send to work/beg Take loans/buy on credit Reduce meal size Skip meals Communities reported that residents used extreme food-based coping strategies to deal with insufficient income. 10 67 communities reported that residents had enough income to cover household needs. The most commonly reported coping strategies to deal with a lack of income in the remaining 382 assessed communities were: 6,7,9 89++ +29+26++ 20+ +13 86% 29% 26% 20% 13% Insufficient food reported Somewhat sufficient food reported Sufficient food reported Governorate capital Sub-district with assessed communities Sub-district with no assessed communities Most commonly reported main sources of income: 6,7 Most commonly reported ways of obtaining food: 6,7 Income from farm ownership Unstable/daily employment Business or trade Remittances 68+58+51+47+42 Stable/salaried employment 42% 68% 58% 51% 47% Purchased Own production Bartered Received from others Food distribution 100+75+22+13+8 100% 75% 22% 13% 8% 5

FOOD SECURITY & LIVELIHOODS Core food item prices reported (in SYP): 1,12 Food item: EDUCATION Regional average price in October: One month change: Six month change: Bread (8 pieces) 135 27% 12% Rice (1 kilogram) 450-10% 0% Lentils (1 kilogram) 300-4% 0% Sugar (1 kilogram) 300 0% 8% Cooking oil (1 litre)* 500 8% 3% *includes the combined vegetable oil and ghee prices 41 communities reported that residents experienced no challenges in accessing food. The most common difficulties experienced in the remaining 408 assessed communities were: 6,7,9 Some items too expensive Lack of resources to buy food Decrease in local food production Some items unavailable 77+71+23+22+21+6+2 Lack of access to market 21% Lack of access to available cooking fuel Lack of available cooking fuel Prevalence of barriers to accessing education services: 77% 71% 23% 22% 6% 2% 441/449 communities reported having functioning primary education facilities, while 219 communities reported having functioning secondary education facilities. 13 167 communities reported that all children were able to access education. The most commonly reported barriers to education in the remaining 282 assessed communities were: 6,7,9 Lack of school supplies Lack of teaching staff Services are too far Parents disapprove of curriculum 51+48+23+23+23 Child labour 23% 51% 48% 23% 23% Governorate capital Barriers to accessing education reported All children reportedly accessed education services during the most recent term Schools in one or more assessed communities in sub-district reportedly destroyed No schools in assessed communities in sub-district reportedly destroyed 6

Northeast Syria, October 2018 Communities that reported insufficient amounts of water to meet household needs:11 WASH 153/449 Communities reported that water from their primary source tasted and/or smelled bad. 28/449 Communities reported that drinking water from their primary source made people sick. 206 communities reported that residents had no problems with latrines. The most commonly reported problems with latrines in the remaining 243 assessed communities were:5,7,9 No water to flush Blocked connections to sewage Not clean Lack of privacy No separation between men and women Too crowded/not sufficient Not safe 7468+ 60+ 20+ 17+ 17+ 2+ 2+ 7836+ 188+ Inability to empty septic tanks 74% 60% 20% 17% 17% 2% 2% 336 communities reported that they had sufficient amounts of water to meet household needs. The most common coping strategies to deal with a lack of water in the remaining 111 assessed communities were:6,7,9 78% Modify hygiene practices 36% Drink water usually used for other purposes than drinking Insufficient water reported Sufficient water reported Governorate capital Water in one or more assessed communities in sub-district reportedly tastes/smells bad or makes people sick Water is reportedly fine to drink in all assessed communities in sub-district Primary drinking water source reported:7 Spend money usually spent on other things to buy water Reduce drinking water consumption 68% 18% 8% 51+25+2021A 51% Network Primary method of garbage disposal reported:6,7 25% Water trucking Free public collection 31% 20% Closed well Disposed of at designated site 27% 2% River Buried or burned 17% 1% Open well Left in street/public area 14% 1% Bottled water Paid private collection 10% 7

Northeast Syria, October 2018 HEALTH Presence of health facilities in assessed communities: 204/449 133/449 Communities reported that no assessed medical items were available in their community.14 34/137 Communities reported that some individuals had been diagnosed with SAM (Severe Acute Malnutrition).15 Communities reported that the majority of women did not give birth in a formal health facility. 19 communities reported that residents experienced no barriers to accessing healthcare services. The most commonly reported barriers in the remaining 430 assessed communities were:6,7,9 High cost of transportation to facilities No health facilities available in the area 6360+4532+129 6360+40 Healthcare services too expensive 63% 60% 45% Lack of transportation/long distance to facilities 32% Lack of medical staff and specialised doctors 12% Old age preventing travel 9% Sub-district with assessed communities Sub-district with no assessed communities Top 3 most common health problems reported:6,7 Top 3 most needed healthcare services reported:6,7 294 communities reported that residents were not using coping strategies to deal with a lack of medical services and items. The coping strategies used in the remaining 155 communities were:6,7,9 Using less than the recommended dose of medication No health facilities reportedly available in area Health facilities reportedly available in area Governorate capital Surgical care 57% Chronic diseases 66% 60% Chronic disease support 53% Acute respiratory Infections 50% 40% Antenatal care 49% Severe diseases affecting those younger than 5 43% +63 63% Using low quality medication Using non-medical items for treatment 8

SHELTER AND NFI Communities that reported insufficient amounts of fuel to meet household needs: 11 3,740 SYP Regional average monthly reported rent price in SYP across assessed communities. 1 5,240 SYP Northern Syria average monthly reported rent price in SYP across assessed communities. 1,16 Most commonly reported shelter type for PCP households: 7 Independent apartment/house Shared apartment/house 99 +1 +1 +1 Unfinished apartment/house <1% Tent Most commonly reported shelter type for IDP households: 7 99% <1% Independent apartment/house Shared apartment/house Tent 58+26+8+5Unfinished apartment/house <1% 58% 26% 8% 5% Insufficient fuel reported Sufficient fuel reported Governorate capital Sub-district with assessed communities Sub-district with no assessed communities Reported fuel prices (in SYP): 1,2 Fuel type (1L): Regional average price in October: One month change: Six month change: GoS petrol 118-66% -53% GoS diesel 55-15% 10% Manually refined petrol 175-13% -18% Manually refined diesel 113 18% 58% Cooking fuel 125 0% 25% 386 communities reported no lack of fuel. Most common strategies to cope with lack of fuel in the remaining 63 assessed communities: 6,7,9 Primary source of electricity reported: 7 46+52+1+1A Burning productive assets 43% Burning waste 32% Burning furniture not in use 30% Cutting trees to burn 22% Burning plastic 21% 52% 46% 1% 1% Generator Network No source Solar power 9

METHODOLOGY HSOS data collection is conducted through an enumerator network in accessible locations throughout Idleb, Aleppo, Hama, Homs,,, and governorates. REACH enumerators are based inside Syria and interview Key Informants (KIs) directly in the community about which they are reporting. Where access and security constraints renders direct data collection unfeasible, some KI interviews are conducted remotely through participants identified in camps and settlements in neighbouring countries by REACH field teams. Participants contact multiple KIs in their community in Syria to collect information about their community. KIs are asked to report at the community level. KIs generally included local council members, Syrian NGO workers, medical professionals, teachers, shop owners and farmers, among others, and were chosen based on their community-level or sector specific knowledge. In cases where KIs disagree on a certain piece of information, enumerators triangulate the data with secondary sources or select the response provided by the KI with the more relevant sector-specific background. For each question asked, confidence levels are assigned based on the KIs area of expertise and knowledge of the sector-specific situation. The confidence levels associated with each question are presented in the final dataset. The full confidence matrix used to assign confidence levels is available upon request. Findings are triangulated through secondary sources, including news monitoring and humanitarian reports. Where necessary, follow-up is conducted with enumerators and participants. Findings are indicative rather than representative, and should not be generalised across the region. About REACH REACH is a joint initiative of two international non-governmental organisations - ACTED and IMPACT Initiatives - and the UN Operational Satellite Applications Programme (UNOSAT). REACH aims to strengthen evidence-based decision making by aid actors through efficient data collection, management and analysis before, during and after an emergency. By doing so, REACH contributes to ensuring that communities affected by emergencies receive the support they need. All REACH activities are conducted in support to, and within the framework of, inter-agency aid coordination mechanisms. For more information, please visit our website: www.reach-initiative.org. You can contact us directly at: geneva@reach-initiaitive.org and follow us on Twitter: @REACH_info. ENDNOTES KEY EVENTS AND DEVELOPMENTS a Sen. (18 October 2017). After the Battle for Raqqa, Now Comes the Hard Part. News Deeply. Retrieved from https://www.newsdeeply.com/syria. b UNHCR. (21 January 2018). Syria Crisis: Northeast Syria Situation Report No. 20 (1 December 31 December 2017). Retrieved from https://reliefweb.int. c Syrian Observatory for Human Rights. (4 April 2018). The International Coalition and SDF prepare for a massive military operation against ISIS amid alertness in the east of the Euphrates River and south of Al-Hasakah. Retrieved from https://www.syriahr.com. d UN Office for the Coordination of Humanitarian Affairs (31 October 2018). Syria Crisis: Northeast Syria Situation Report No. 29 (1 October 2018-31 October 2018). Retrieved from https://reliefweb.int. e El Dahan, M. (9 October 2018). War and drought produce Syria s smallest wheat crop in 30 years: U.N. Reuters. Retrieved from https://www.reuters.com. f UN Children s Fund (31 October 2018). UNICEF Syria Crisis Situation Report - October 2018 Humanitarian Results. Retrieved from https://reliefweb.int. MAIN TEXT 1 1 USD = 434 SYP (UN operational rates of exchange as of 1 October 2018) 2 18 items comprise the Survival Minimum Expenditure Basket (SMEB), which represents the minimum culturally adjusted items required to support a 6-person household for a month. SMEB items: Bread, bulgur, chicken, eggs, fresh vegetables, ghee/vegetable oil, red lentils, rice, salt, sugar, tomato paste, bathing soap, laundry/dish soap, sanitary pads, toothpaste, cooking fuel, water trucking, smartphone data, float (other costs). 3 All information and figures reported in HSOS factsheets refer to the situation in assessed communities and cannot be generalised to other non-assessed communities of the region. 4 For population numbers, KIs were asked to provide the number of resident and IDPs present in the community as of 31 October 2018. A minimum of three KIs were interviewed in each assessed community. Where discrepancies in the information provided by KIs was deemed too large further triangulation with additional KIs and local organizations was conducted. Estimated individual figures in this report are rounded to the nearest tenth. Discrepancies with other available population data may be the result of any of the following: differences in 10

MAIN TEXT assessment coverage dates; differences in definitions of population sub-groups (IDPs and residents); differences in geographic scope of assessed locations (e.g. included/excluded nearby camps and sites); differences in KI types interviewed; and differences in average household sizes used to calculate individual numbers, among others. The definition of IDPs used by enumerators for this assessment was Individuals or groups of people who have been forced to leave their homes or places of habitual residence, in particular as a result of or in order to avoid the effects of armed conflict, situations of generalised violence, violations of human rights, or natural or man-made disasters, and who have not crossed an international border. 5 Spontaneous returns refers to IDPs or refugees who return to their community of origin that they left due to conflict but not necessarily to their places of habitual residence (their former homes); who intend to remain in the community for an undetermined period; and who do not meet the IASC framework on durable solutions (IASC framework includes not necessarily voluntary, safe or sustainable elements ). 6 Assessed using select multiple questions. 13 Reported numbers indicate the number of communities with functioning primary and secondary education facilities during the data collection period. It is important to note that simply having a functioning facility is not indicative of students being able to attend said facility. In addition, in some cases KIs reported that children attend schools in a neighbouring community. 14 Assessed HSOS medical items; anti-anxiety medication, contraception, clean bandages, blood transfusion bags, diabetes medicine, anaesthetics, blood pressure medicine, antibiotics, burn treatment. 15 This information was derived from medical professionals (KIs). The number of total communities refers to all communities that had a KI as medical professional available. 16 Includes HSOS data for Idleb, Aleppo, Hama, Homs,, and governorates. 7 By percentage of communities reporting. 8 The definition of resident (pre-conflict) population (PCP), was Individuals or groups of people who currently reside in their communities of origin, or communities of permanent residence prior to the Syrian conflict. This includes populations that were never displaced as well as previously displaced populations that have returned to their communities of origin. 9 Not all surveys have answers for every question, in these scenarios the KI or participant will input no answer. When the dataset has no answer for a particular question the reported number of assessed communities will not add up to to total number of communities assessed and percentages will be calculated based on submitted responses. 10 Extreme food-based strategies: eating food waste; eating non-edible plants and spending days without eating. 11 Based on KI perception of sufficiency. 12 Bread, rice, lentils, sugar, and cooking oil are considered core food items used in food baskets across Syria. For further information on all SMEB items please see the Syria Market Monitoring report. 11